Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: a cross-sectional study

Abstract

BackgroundNigeria ranks fourth among 22 high tuberculosis (TB) burden countries. Although it reached 99% DOTS coverage in 2008, current case detection rate is 40%. Little is known about delays before the start of TB therapy and health-seeking behaviour of TB patients in rural resource-limited settings. We aimed to: 1) assess healthcare-seeking behaviour and delay in treatment of pulmonary TB patients, 2) identify the determinants of the delay in treatment of pulmonary TB.MethodsWe conducted a cross-sectional study of adult new pulmonary TB patients notified to the National Tuberculosis Control Programme (NTP) by three rural (two mission/one public) hospitals. Data on health-seeking and delays were collected using a standardised questionnaire. We defined patient delay as the interval (weeks) between the onset of cough and the first visit to any health provider, and health system delay as the time interval (weeks) between patient's first attendance to any health provider, and the onset of treatment. Total delay is the sum of both delays. Multiple linear regression models using nine exposure variables were built to identify determinants of delays.ResultsOf 450 patients (median age 30 years) enrolled, most were males (55%), subsistent farmers (49%), rural residents (78%); and 39% had no formal education. About 84% of patients reported first consulting a non-NTP provider. For such patients, the first facilities visited after onset of symptoms were drug shops (79%), traditional healers (10%), and private hospitals (10%). The median total delay was 11 (IQR 9–16) weeks, patient delay 8 (IQR 8–12) and health system (HS) delay 3 (IQR 1–4) weeks. Factors associated with increased patient delay were older age (P <0.001) longer walking distance to a public facility (<0.001), and urban residence (P <0.001). Male gender (P = 0.001) and an initial visit to a non-NTP provider (P = 0.025) were independent determinants of prolonged HS delay. Those associated with longer total delay were older age (P <0.001), male gender (P = 0.045), and urban residence (P<0.001).ConclusionOverall, TB treatment delays were high; and needs to be reduced in Nigeria. This may be achieved through improved access to care, further education of patients, engagement of informal care providers, and strengthening of existing public-private partnerships in TB control.

Treatment outcomes of new smear positive pulmonary tuberculosis patients under directly observed treatment in Anambra state, Nigeria

“…This is consistent with the report of Akintola et al that non-compliance are associated with poor education of patients on TB therapy [11]. It is also similar to the finding of Ukwaja et al that low knowledge of TB and therapy is a predictive factor of adverse treatment outcome among tuberculosis patients [27]. Enhanced patient counseling and education on tuberculosis will help reduce unsuccessful treatment outcomes.…”

“…The reason for this finding could be a result of higher risk of TB infection in this class, coupled with low self-esteem and health seeking behavior [27].…”

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

“…494,495 Furthermore, from a programmatic point of view, focusing solely on prevention of infection risk late in the course of the disease overlooks the fact that most transmission probably occurs before diagnosis in the community. [496][497][498][499] Enforced confinement is a poor strategy to prevent transmission at a community level, might drive the epidemic underground, and is not justified as a routine measure.…”

Treatment Delay among Smear Positive Pulmonary Tuberculosis Patients in South Ethiopia: A Cross-Sectional Study

“…Increased distance requires additional cost for transportation which hinders the patient to visit health facility as early as possible [6][7][8][9][10][11][12][13]. As it is known as the most important risk factor for TB, smoking cigarette also increases the delay for diagnosis and treatment as compared to non-smokers and ex-smokers [14].…”